<!DOCTYPE html>
<html>
	{include file="public/header" /}
	<body>
		<div class="layui-form" lay-filter="layuiadmin-form-admin" id="layuiadmin-form-admin" style="padding: 20px 30px 0 0;">
			
			<div class="layui-form-item">
				<label class="layui-form-label">订单号</label>
				<div class="layui-input-inline">
					<input type="text" name="OrderSn" lay-verify="required" placeholder="请输入用户名" autocomplete="off" class="layui-input" value="{$data.OrderSn}">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label">真实姓名</label>
				<div class="layui-input-inline">
					<input type="text" name="TrueName" lay-verify="required" placeholder="请输入真实姓名" autocomplete="off" class="layui-input" value="{$data.TrueName}">
				</div>
				
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label">申请金额</label>
				<div class="layui-input-inline">
					<input type="text" name="ApplyMoney" lay-verify="required" placeholder="请输入真实姓名" autocomplete="off" class="layui-input" value="{$data.ApplyMoney}">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label">银行卡号</label>
				<div class="layui-input-inline">
					<input type="text" name="BankNo" lay-verify="required" placeholder="请输入真实姓名" autocomplete="off" class="layui-input" value="{$data.BankNo}">
				</div>
			</div>
    	<input type="hidden" name="ID" lay-verify="required" placeholder="隐藏域 编辑用户ID" autocomplete="off" class="layui-input" value="{$data.ID}">
			<div class="layui-form-item layui-hide">
				<button class="layui-btn" lay-submit lay-filter="LAY-user-back-submit" id="LAY-user-back-submit">提交</button>
			</div>
		</div>
		<!--<script src="../../../layuiadmin/layui/layui.js"></script>-->
		{include file="public/footer" /}
		<script>
			layui.use(['form'], function() {
				var $ = layui.$,
					form = layui.form;
			})
		</script>
	</body>

</html>